尿源性脓毒血症严重程度的相关因素分析

目的回顾分析临床白细胞（WBC）、中性粒细胞百分比（N%）、血小板（PLT）、纤维蛋白原（FIB）、D-二聚体（D-Dimer）、白细 胞介素-6（IL-6）、降钙素原（PCT）、C反应蛋白（CRP）等炎性指标，与尿源性脓毒血症严重程度的相关性，为临床早期诊治尿源性 脓毒血症提供临床参考及指导。方法回顾分析2013年1月~2018年4月我院泌尿外科收治尿源性脓毒血症患者的临床资料70 例。根据2014版（中国泌尿外科疾病诊断治疗指南）感染性休克和脓毒血症的临床诊断标准分组：A组（脓毒症组）22 例；B组 （低血压+严重脓毒血症组）12 例；C组（感染性休克组）17 例；D组（难治性感染性休克组）19 例；比较患者的WBC、N%、PLT、 FIB、D-Dimer、IL-6、PCT、CRP的差异；应用Logistic 回归分析炎性指标与脓毒血症的相关性，评价炎性指标对病情严重程度的 相关影响。结果（1）不服从正态分布的炎性指标进行Kruskal-Wallis检验表明：N%、PLT、D-Dimer、PCT在尿脓毒血症严重程 度组别上的P<0.05，差异有统计学意义；CRP符合正态分布及方差齐，单因素方差分析后提示CRP在脓毒血症不同组别上 的P>0.05，差异无统计学意义；（2）Kruskal-Wallis事后检验两两比较：N%在A-B、A-C、A-D组之间差异有统计学意义；PLT在AC 、A-D组之间差异有统计学意义；D-Dimer在A-C组之间差异有统计学意义；PCT在A-B、A-C、A-D组之间差异有统计学意义； 比较炎性指标不同组别的中位数结果提示：PLT数量随脓毒血症严重程度加重而减少，PCT随脓毒血症严重程度升高而上升； N%随脓毒血症严重程度升高而上升；（3）炎性指标的有序Logistic回归提示：PCT的P=0.000，回归系数为0.186；N%显著性检验 P=0.035，回归系数为0.047；PLT显著性检验P=0.003，回归系数为-0.012，差异有统计学意义。结论PCT血清波动与尿源性脓 毒血症病情严重程度呈正相关；PLT与尿源性脓毒血症严重程度呈负相关；N%随脓毒血症病情加重而变化，PCT、PLT、N%动态 联合检测可以作为脓毒血症患者严重程度的参考指标指导临床治疗。

Association of inflammatory indices with the severity of urinary sepsis: analysis of 70 cases

Objective To analyze the association of the clinical inflammatory indices with the severity of urinary sepsis. Methods We reviewed the clinical data of 70 patients with urinary sepsis treated in our hospital between January, 2013 and April, 2018. All the patients were diagnosed in line with the Guidelines for Diagnosis and Treatment of Urological Diseases in China (2014 edition), including 22 patients with sepsis, 12 with hypotension and severe sepsis, 17 with septic shock, and 19 with critical septic shock. White blood cell count (WBC), neutrophil percentage (N% ), platelets (PLT), fibrinogen (FIB), Ddimer, interleukin-6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP) were examined in all the cases and compared among the 4 groups. The correlations of these inflammatory markers with the severity of sepsis were analyzed using logistic regression analysis. Results The 4 groups of patients showed significant differences in N%, PLT, D-dimer, and PCT (P<0.05) but not in CRP (P>0.05). Kruskal-Wallis Pairwise comparisons showed that the N% and PCT in patients with sepsis differed significantly from those in the other 3 groups; platelets in patients with sepsis differed significantly from those in patients with septic shock and critical septic shock; D-dimer differed significantly between patients with sepsis and those with septic shock. Among the 4 groups, the median levels of PLT decreased and PCT and N% increased with the worsening of sepsis. Logistic regression analysis indicated that PCT (r=0.186, P=0.000), N% (r=0.047, P=0.035) and PLT (r=-0.012, P=0.003) were significantly correlated with the severity of sepsis in these patients. Conclusion PCT, PLT and N% are all significantly correlated with the severity of sepsis, and their combined detection can be informative for assessing the severity of sepsis to facilitate clinical decisions on treatment.